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General NPI Number Information
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NPI Number | 1144701889
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Entity Type | Organization
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Legal Business Name | JULIA A. HALLISY D.D.S., INC.
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 345 W PORTAL AVE STE 210
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1429
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Country | US
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Telephone | 415-681-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 345 W PORTAL AVE STE 210
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1429
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Country | US
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Telephone | 415-681-1011
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JULIA ANN HALLISY
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Credential | DDS
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Telephone | 415-385-5869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36659
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License Number State | CA
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